Provider Demographics
NPI:1720038318
Name:DESAD, INC.
Entity Type:Organization
Organization Name:DESAD, INC.
Other - Org Name:VITA CARE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAITE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-674-2181
Mailing Address - Street 1:4485 POST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3033
Mailing Address - Country:US
Mailing Address - Phone:305-674-2181
Mailing Address - Fax:
Practice Address - Street 1:8000 W FLAGLER ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2153
Practice Address - Country:US
Practice Address - Phone:305-262-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4118Medicare ID - Type Unspecified